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In the context of breast cancer, women who refuse reconstruction are often portrayed as having limited agency or control over their bodies and treatment. Here we assess these assumptions by paying attention to how the local contexts and inter-relational dynamics influence women's decision-making about their mastectomized body in Central Vietnam. We situate the reconstructive decision within an under-funded public health system, but also show how the widespread perception of the surgery as merely an aesthetic practice dissuades women from seeking reconstruction. Women are shown both conform to existing gendered norms while simultaneously challenging and defying them. [ABSTRACT FROM AUTHOR]

The aim is to understand what therapies and interventions families in a low and middle income (LMIC) country, such as Vietnam resort to in their attempts to seek care for their children with ASD and why they choose these therapies. We undertook semi-structured qualitative interviews with 27 parents of children with autism and an online survey of 112 parents as part of a broader ethnographic study over one year augmented with recent interactional observations and a review of social media. There is limited access to formal interventions for families with children with ASD in Vietnam. Rather, families resort to syncretic care using an average of 6.8 different interventions per child. These included: speech therapy; physical therapy; prescribed medicines; and ABA as well as geomancy, special dietary regimes, biochemical testing, stem cell therapies and religious and cultural practices. Despite having low incomes, the families surveyed spent an average USD 345 per month on interventions, many of which are not evidence-based. Desire to care and potentially "cure" their children within a context of stigma associated with ASD drives parents to seek all possible interventions for their children. There remains a large gap in access to appropriate evidence-based interventions or trained therapists for families. Further information for parents, culturally appropriate guidelines for effective interventions, more trained rehabilitation professionals and regulation is required. Within low and middle income countries (LMIC), such as Vietnam there is a lack of intervention services, difficulties in accessing appropriate specialists, poor quality care and the costs of care. Families seek a range of formal interventions and costly informal therapies as well as culturally specific practices to care for their child/ren and require information on effective therapies. In LMIC training programs to build capacity for allied health professionals need to be implemented on the latest evidence-based therapies. It is important to develop culturally appropriate Vietnamese guidelines to support interventions for children with ASD. [ABSTRACT FROM AUTHOR]

Background: Cross‐border surrogacy and egg donor arrangements are an increasingly common means to family building. Establishing patterns of use has always been difficult in relation to Australian patients. Accurate data is stymied by lack of documentation of international third‐party reproductive care available to Australian authorities. When international travel bans came into effect, it is hypothesised that those planning to use cross‐border reproductive care had to rely significantly more on local in vitro fertilisation (IVF) clinics for services such as sperm freezing, embryo creation and gamete release procedures. Aim: To quantify and characterise the impact of the Covid‐19‐related travel ban on international and interstate gamete shipping by Australian IVF clinics. Materials and methods: Thirty‐one Australian and New Zealand IVF clinics were invited to provide de‐identified data on interstate and international gamete export applications from two 12 month time periods pre‐ and during Covid‐19‐related international travel lockdowns. Seven IVF organisations provided data on: patient age; type of gametes exported; destination country/state; and date gamete release approved. Results: Most gametes (78%) were shipped to another Australian IVF clinic and 22% internationally. Patient‐initiated shipping domestically and internationally both showed significant increases when comparing pre‐ and post‐Covid datasets. Of the 21 destination countries reported for international shipments, the US was the commonest (39%), followed by Ukraine (21%) and Canada (9%). Conclusions: The inability of involuntarily infertile patients to travel internationally, rather than halt cross‐border reproductive care, has led to a significant increase in the uptake of gamete shipping. The high proportion of internationally shipped gametes going to the US and Ukraine is likely a reflection of the availability of surrogates and donors and more amenable legal frameworks. [ABSTRACT FROM AUTHOR]

Behind the statistics forecasting millions of deaths associated with antimicrobial resistance (AMR) is an even greater burden of morbidity leaving many people with long-term chronic illnesses and disability. Despite growing recognition of the importance of inter-sectoral and inter-disciplinary knowledge in forming responses to address this global health threat, there remains a paucity of social science research to understand the social burdens of AMR. In this qualitative study we explore the experiences of people living with chronic AMR infections, their interactions with health providers and therapeutic quests for care, and the effects upon their lives and that of their families and caregivers. Our analysis reveals that the resistant infections impacted not only the physical health but also the mental health of the sufferers and their caregivers, causing major disruptions to their social and work lives. Most undertook arduous treatment regimes – of powerful antibiotics with debilitating side effects, combined a range of other complementary and alternate therapies, including travel to seek treatment overseas. Further, we question the notion of 'AMR survivorship' currently being promoted as part of a public education campaign by the World Health Organisation and whether people with the diverse AMR experience really self-identify as 'survivors' of a biosocial group. [ABSTRACT FROM AUTHOR]

Gestational surrogacy is a reproductive arrangement where a woman gestates a child for others—the "intended parents"—in order to be handed over to them after birth. Since the turn of the millennium, demands for surrogacy have continuously increased due to social and demographic changes, rising rates of infertility, and the normalization of new, non-heteronormative, family forms. Many countries prohibit surrogacy, and others that previously permitted this reproductive arrangement closed down as a result of political decisions or surrogacy scandals. Moreover, surrogacy is offered at greatly varying costs, ranging from approximately US$50,000 in countries like the Republic of Georgia to US$200,000 in fertility clinics in California. Accordingly, many of these arrangements are transnational, with intended parents who cannot access surrogacy or afford surrogacy in their home country commissioning it in countries such as the United States, until recently Ukraine, and today increasingly in the Republic of Georgia. Existing research has focused on surrogacy from different angles, such as practices of kinning and de-kinning, inequality and stratification, the political economy of the fertility industry, and its gender dimensions. We engage in, but further these debates by drawing attention to settings, accounts, experiences, and new theoretical notions that diverge from "mainstream" presentations of surrogacy. Moreover, in this Special Issue, we experimented with writing joint papers with a deliberative aim to provide comparative analyses and emphasize the links between and diversity of different cases of surrogacy. Therefore, all papers have an explicit comparative character and are all based on empirical studies from more than one field site. They provide nuanced understandings of surrogacy arrangements, grounded in empirical data rather than ideological, political, or moral assessments. [ABSTRACT FROM AUTHOR]

In this article, we offer an analysis of the development of "repronubs": less-known locations offering small-scale, niche cross-border gestational surrogacy or surrogacy services for a regional market. This analytical category of "repronubs" is useful to describe the formation of the industry from small local sites to those offering cross-border services. Based on our work in these locations, we compare the markets, regulatory contexts, and organization of the industry in Ghana, Kazakhstan, and Laos, focusing on the "repropreneurs" or surrogacy facilitation agents as pivotal in the emergence of these sites. These "repronubs" highlight the surrogacy trade between countries of the Global South and are established next to or instead of the more well-known North–South destinations. We document how surrogacy itself is increasingly stratified between higher cost and better-regulated environments such as in certain states of the United States or Canada and lower cost, less well regulated, and regionally focused environments in the settings we describe. These locations are characterized by poor or liberal regulations, the existence of local in vitro fertilization (IVF) expertise, and the emergence of local repropreneurs driving the trade using their social networks. The growth of demand from China and the growing affluent middle class in Africa is creating further markets for such regional "nubs." Studying surrogacy in such locations is made difficult by the secrecy and confidentiality surrounding it. [ABSTRACT FROM AUTHOR]

Women in low‐ and middle‐income countries where the prevalence and mortality of breast cancer are growing rapidly are more likely to be diagnosed at advanced stages, which negatively affects their treatment outcomes and chance of survival. The current literature in those settings tends to focus largely on explaining patient delay in seeking medical attention for breast symptoms. Meanwhile, little is known as to what prompts women to attend screening and diagnostic services after discovering symptomatic breasts. Drawn upon the data from in‐depth interviews with 33 breast cancer patients in Central Vietnam conducted in 2019, this paper examines the context of women's decisions about breast screening and how the practice of seeking cancer diagnosis occurred. Our findings reveal an absence of a national screening program and that seeking medical advice was conducted on an ad hoc basis after self‐detection of breast symptoms. Women's interpretations of symptomatic breasts as suspicious signs of cancer, the co‐occurrence of important life events, or encouragement by people in their social network motivated women to seek medical attention at different public and private health facilities. Their encounters with the health sector often involved multiple visits across time and space in which they experienced various forms of diagnosis delay produced by the health system. Our study carries implications for interventions to encourage women's awareness of early cancer symptoms and prompt medical presentation after self‐discovery of symptomatic breasts. [ABSTRACT FROM AUTHOR]

The availability of women willing to donate eggs in Spain is one of the cornerstones that has led the country to become the most desirable European destination for cross-border reproductive care. The reasons for this success are usually attributed to legal and socioeconomic conditions. Much less attention has been paid to the online strategies that fertility clinics in Spain use to inform and recruit young women to become egg providers. This paper addresses this gap by analysing online communication strategies in egg donors' websites and social media. The narratives and rationalities they underpin are conceptualised as revealing 'sociotechnical imaginaries' around egg donation which coproduce new societal interests among young women. The results show that the language used recycles and repurposes egg donors' motivations towards a normative discourse that puts altruism at the core, while, at the same time, explanations of medical processes and risks generate incomplete and misleading narratives. Finally, this paper describes how these discourses are embedded in a particular kind of branding where not only the notion of altruism is produced but also a complete identity framework. In this framework, donating eggs would not just be an act of solidarity, but would also imply belonging to a community of progressive empowered women, in control over their bodies and with modern consumption capacity: a neoliberal rationality of optimization, self-care and consumerism as forms of liberation. [ABSTRACT FROM AUTHOR]

In this paper, I consider how the 'new hysteria' of uterus transplants (UTx) continues traditions of medical experimentation focussed upon the correction of the defective female body. Media accounts of 'first' UTx events in the US are analysed to describe the narrative 'anchors' used in these accounts. In Sweden and Denmark, UTx is presented within the media as a means to avoid surrogacy, while in the US UTx is constructed as an alternate choice to surrogacy in keeping with the US emphasis on neoliberal choices. These differing approaches to surrogacy and UTx reflect the different social contexts. In media accounts, risks are minimised and success is emphasised, and the potentials of UTx for non-heteronormative reproduction are not mentioned. Despite parallels with other forms of transplantation and surrogacy markets, public representations avoid the potential of a future UTx market. [ABSTRACT FROM AUTHOR]

Background: Birth is a significant event in women's lives. As Mansfield notes (2008) many women aim for a birth that avoids pharmacological pain relief because they are advised it is better for them and their baby. For women having their first baby, this may not be realistic as 3/4 of primiparous women in Australia will use pharmacological pain relief. This study examines the expectations that a group of women had regarding pain relief, how these expectations developed and what happened to requests for pain relief in labour. Methods: A longitudinal prospective study design was used to recruit 15 women who were having their first baby. Women having low risk pregnancies, hoping for a 'natural birth' (vaginal, no/minimal pharmacological pain relief) were eligible. A semi-structured interview tool was used across all three interviews that asked women about their expectations, then actual labour experience, pain management requests and how these were responded to by carers. Fifteen women were interviewed – at 36 weeks gestation; as soon after delivery of their baby as possible, then six months post-delivery (N = 43 interviews). Interviews were recorded and transcribed and coded by ES using NVivo software with hierarchical thematic analysis used. Results: The study found that women appear to experience a mismatch between expectations they had developed pre-birth, versus actual experience. This appears to cause a specific form of dissonance – which we have termed 'birth dissonance' leaving them feeling traumatised post birth. This is because what women expected to happen in birth was often not realised. In particular, some women requested pain relief in birth and felt that their request was not responded to as hoped, and also seemed to develop post-birth trauma. We proposed that this may have resulted from dissonance arising from their expectations about being able to birth without significant pain relief. Interventions and technology may also contribute to this sense of mismatch and post-birth trauma. Conclusions: Low risk birthing women birthing in a hospital may have to engage with higher levels of technology, intervention and pain relief than that which they expected pre-birth. This could possibly be avoided with four simple changes. Firstly, better pre-birth education for women about how painful labor is likely to be. Secondly, pre-birth education which includes a detailed explanation of the utility of pharmacological and non-pharmacological pain relief. Thirdly, more egalitarian decision-making during labour and finally delivering upon women's requests for pain relief in labor, at the time that they ask for it. Further research is required to determine the extent of birth dissonance and how women making the transition to motherhood can avoid it. [ABSTRACT FROM AUTHOR]

This paper employs an assemblage lens to generate analyses of general public narratives on antimicrobial resistance (AMR). Global efforts to reduce AMR include communications aiming to promote general public awareness, provide knowledge, encourage careful antibiotics use, and discourage demands for them. These efforts are somewhat compromised by the assumptions they make of individual lack of knowledge and motivation and the manner in which the AMR problem is framed in isolation from the biological, social and economic structures that produce it. Conceptualising AMR as an effect of antimicrobial assemblages of which publics are but one part, we analysed interviews with the general public on the lived experience of infections, antibiotic treatments and AMR. Far from science and policy discourse on AMR, these narratives showed antibiotics to be partly solutions to the social and biomedical challenges of infection, framed by self-defensive immunity and hygiene, the affective benefits of 'immune boosting', and the imperative to sustain the moral standing of the healthy citizen. Failing public awareness and action on AMR can be attributed to public health messages that overlook the social, affective and moral dimensions of infection care and separate AMR from its socio-economic drivers. [ABSTRACT FROM AUTHOR]

Individual antibiotic use for common infections is a focus for public health efforts seeking to prevent antimicrobial resistance (AMR). These approaches employ a binary opposition of responsible and irresponsible antibiotic use with a focus on the knowledge, behaviours and intentions of the individual. To overcome these unhelpful tendencies and reveal new entry points for AMR prevention, we adopted assemblage theory to analyse personal experience narratives on individual antibiotic use in community settings. Antibiotic use was irregular, situationally diverse and shaped by factors not always under personal control. Individuals were focussed on preventing, moderating and treating infections that threatened their health. Our analysis shows that antibiotic assemblages are both cause and effect of individual efforts to manage infections. We suggest that AMR prevention needs to look beyond the antibiotic as object and the (ir)responsible use binary to engage with the antibiotic effects individuals seek in order to manage infectious diseases. This antibiotic assemblage orientation is likely to be more meaningful for individuals seeking out methods for promoting their health in the face of common infections. • Antimicrobial resistance prevention is proving difficult in community settings. • Prevention focus on patient knowledge and behaviour has proved ineffective. • Assemblage theory offers new entry points for prevention. • Antibiotic effects depend on the action of biosocial systems. • Effective prevention needs to focus on system drivers of antibiotic use. [ABSTRACT FROM AUTHOR]